Primary lung adenocarcinoma: characteristics by smoking habit and sex

The incidence of adenocarcinoma is increasing, particularly among females. We sought to assess the role of tobacco consumption in clinical presentation according to sex. In this retrospective study, 848 patients diagnosed between 1997 and 2006 at Grenoble University Hospital (Grenoble, France) were stratified into four groups according to smoking habits. Differences between sexes and two contrasting female profiles emerged. Female current smokers were younger than female never-smokers (median 51 versus 69 yrs; p<0.001), more often had surgery (62.7% versus 39%; p=0.01) and had a median (95% CI) estimated survival of 26.2 (18.1-49.2) versus 15.1 (12.8-22.2) months (p=0.002). Both groups had similar survival when taking treatment into account. Among males, smoking did not influence presentation. Male current smokers were older than female current smokers (median 59 yrs; p<0.001) and fewer had surgery (48.8%; p=0.015), although the percentage of stage IIIb-IV disease was similar (53% and 46%; nonsignificant) and they had a poorer estimated survival of 14.3 (13.0-18.5) months (p=0.0024). Males smoked more than females (median 41 versus 30 pack-yrs; p<0.001). Quitting smoking delayed age at diagnosis by 11 yrs for females (p=0.0035) and 8 yrs for males (p<0.001). Our results support the hypothesis that carcinogenesis differs between males and females, and between female smokers and never-smokers.